frozen shoulder

Frozen shoulder? Just roll it

http://www.telegraphindia.com/1160725/jsp/knowhow/story_98489.jsp

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Your Health - Dr. Gita Mathai

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The shoulders are joints with a wide range of motion. That helps us painlessly perform a variety of tasks such as combing hair, applying soap to the back or hooking undergarments. If the movements of the shoulder are restricted due to pain, life becomes difficult.

This may occur because the joint is strained from overexertion, the tendons of the muscles surrounding the joint are inflamed, the joint itself may be unstable and dislocated, or because of neck problems. Most often though, no real disease process can explain the pain and it is called a "frozen shoulder."

Women between 50 and 60 years of age are prone to developing frozen shoulders, especially if they also suffer from hypothyroidism or diabetes. It affects the non-dominant shoulder and is seldom bilateral, but the pain restricts even the simplest two-handed tasks. Men can also develop "frozen shoulders", but it is milder and less common.

A frozen shoulder usually starts as lack of free movement in a normal shoulder joint, with no recollection of overuse or injury. The pain then comes in fits and starts, tends to be worse at night, and interferes with sleep, as turning from side to side produces discomfort. This stage lasts for around three to four months.

Later, during the sticking or freezing phase, all movements are restricted by pain. The shoulder is held fixed to prevent involuntary movement. Subconsciously, use of the affected arm reduces. The muscles around the joint get wasted due to disuse. The rounded contour of the shoulder changes and becomes flattened. Just as suddenly as it starts, it spontaneously, inexplicably improves.

The entire cycle takes around 30 months. In seven per cent of sufferers, it does not fully resolve, and pain and functional disability remain for many years.

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A frozen shoulder is usually diagnosed clinically. The normal procedure is to get X-rays, CT and MRI scans done. However, X-rays may only reveal thinning of the bone due to disuse.

Once the shoulder has become relatively immobile, treatment is essentially symptomatic. During the initial painful stages, treatment is directed at relief. The patient has to determine the limit of activity or exercise, pushing their limits a little further each day. All pain free activities are allowed and all painful activities curtailed.

At home, external application of a capsaicin gel followed by ice offers relief. Professional physiotherapy, with alternating heat and cold therapy, passive movements, low load, prolonged stretches and strengthening exercises are helpful. Physiotherapy provides greater benefit when it is combined with intracapsular steroid injections. Non-steroidal anti-inflammatory drugs (NSAIDs) supplemented with other analgesics may be helpful. Long-term use of these drugs is not advised, as it is detrimental to the kidneys.

If functional disability persists despite physiotherapy and medication for six months, an orthopaedic surgeon can perform manipulation of the joint under anaesthesia. Arthroscopic (surgical) release of the capsule can also be done.

It is better to be patient and manage the symptoms rather than go in for surgery immediately as most people recover spontaneously.

Anyone can develop a frozen shoulder. This makes preventive measures a practical necessity to prevent pain and disability occurring.

Yoga has exercises that prevent frozen shoulder from developing if started young, performed regularly and continued lifelong. Shoulder rolls, arm elevations, arm rotations, the plank pose and a complete suryanamaskar all help to maintain the integrity, position and health of the shoulder joint.

The Chinese Tai-Chi exercises confer similar benefits.

These traditional exercises can be combined with biceps curls, triceps curls and lateral lifts using small one or two kilo "baby" dumbbells.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

blisters and boils

Bubble trouble

http://www.telegraphindia.com/1160718/jsp/knowhow/story_97197.jsp

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Your Health - Dr. Gita Mathai

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A blister is a very superficial lesion, which occurs when the surface layer of the skin gets separated from the deeper layers. Fluid or blood can accumulate in this space. This raises the surface of the skin. A small, translucent or blood-filled bump forms, which may or may not be painful. Blisters can occur singly, in clusters or all over the body.

Single blisters occur on the feet - if shoes are tight or ill fitting - or the hands, if repetitive movements are performed with tools. Exposure to extreme temperatures (both freezing and boiling) can cause a blister.

Blisters can cause throbbing pain because of pressure. The clear liquid or blood that accumulates inside remains uninfected as long as the skin over the blister is intact. Care should be taken to make sure the skin does not break. The protective skin should not be pricked. If you don't disturb it, a blister will usually disappear on its own within a few days. Antibiotic treatment is not required.

Before wearing a new pair of shoes or using tools, take a bar of soap (traditionally, Lifebuoy is used) and rub it on the dry skin. It prevents blisters forming due to friction. Sports people or those in the NCC or military can also wear thick socks.

Bites of bed bugs, scabies mites, mosquitoes and spiders can also cause blisters. These tend to itch. Scratching can lead to the skin breaking, which in turn can cause a secondary infection. In the case of a spider bite, there is a clear blister in the centre surrounded by a red area. It tends to burn, not itch. After a few days, the area in the centre becomes black and the skin sloughs off.

A herpes virus infection also leads to blisters. Multiple blisters, usually on the face, occur and recur in clusters in the same area with the Herpes simplex infection. They are precipitated by other unrelated, incidental infections such as a flu or fever. Their appearance is preceded by a pricking sensation. They last a few days and then disappear spontaneously, only to reappear with the next infection.

Herpes genitalis, a sexually transmitted infection, produces blisters in the genital area. These are extremely painful. The first infection needs to be aggressively treated with antivirals. Despite this, the virus continues to live in the nerve roots in the pelvic area. The ulcers recur painfully every few months. Eventually, the attacks become less frequent and then cease altogether.

Herpes zoster occurs several years after a childhood attack of chicken pox. It causes painful blisters along the distribution of a single nerve. The pain and the blisters take around 10 days to disappear. Although the attacks do not recur, the pain can persist for months or years as "post herpetic neuralgia." The initial attack can be shortened with antiviral medication and the pain lessened with medication. A vaccine is in the pipeline for the prevention of Herpes zoster.

The herpes virus also causes chicken pox. A few days after fever, a rash appears and blisters begin to break out all over the body. They are painless and will subside harmlessly if left alone (not scratched). Attacks occur as epidemics particularly in schools. The disease is contagious from before the appearance of the rash till the blisters have scabbed and fallen off. The duration and severity of the attack can be reduced with antiviral medication. The Varicella vaccine can be administered after the age of one and again at the age of 10 years to prevent chicken pox.

The Coxsackie virus produces highly infectious "hand, foot and mouth'' disease, with blisters in these areas, particularly in young children. It disappears on its own in 7-10 days with no treatment.

So if you have blisters, make sure you don't scratch or burst them and visit the doctor only if they are painful.

Dr Gita Mathai is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in